Provider Demographics
NPI:1891928388
Name:MAYE, NICOLA
Entity type:Individual
Prefix:
First Name:NICOLA
Middle Name:
Last Name:MAYE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2116 HOUSTON AVE
Mailing Address - Street 2:#D
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73071-3305
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2116 HOUSTON AVE
Practice Address - Street 2:#D
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73071-3305
Practice Address - Country:US
Practice Address - Phone:405-410-2278
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-31
Last Update Date:2009-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKL081968268Medicaid